Insomnia During Late Life: Potential Pathways Toward Suicide Risk

As the global population continues to age, the identification of drivers of suicide risk in older adults is of increasing importance. This manuscript explores the link between insomnia and suicide risk in older adults, highlighting the prevalence of sleep disorders in aging populations and their impact on mental and physical health. Potential mechanisms, both physiological and psychological, linking insomnia to suicide risk are explored. Clinical implications and treatment recommendations regarding the intersection of insomnia and suicide are discussed. Recent meta-analyses have examined whether interventions for sleep disorders are (1) efficacious in the older adult population and (2) have a significant role in reducing suicidal ideation. Results from Huang and colleagues’ (Huang K, Li S, He R, Zhong T, Yang H, Chen L, et al. Efficacy of cognitive behavioral therapy for insomnia (CBT-I) in older adults with insomnia: A systematic review and meta-analysis. Australas Psychiatry. 2022;30(5):592–7. The authors report results from a meta analysis of 14 studies to examine the efficacy of cogntivie behavioral therapy for insomnia in older adults. Significant effects were reported for sleep efficiency, sleep onset latency, wake after sleep onset, and total sleep time indicating that this intervention is efficacious in the older adult population.) analyses of 14 studies suggest that cognitive behavioral therapy for insomnia (CBT-I) is effective in improving sleep quality and reducing insomnia symptoms in older adults, reaffirming that CBT-I is an important tool to treating insomnia in this population. In regard to suicidal ideation, Mournet & Kleiman (Mournet AM, Kleiman EM. A systematic review and meta-analysis on the efficacy of sleep interventions to treat suicidal ideation. J Sleep Res. 2024:e14133. The authors report findings from a meta-analysis that evaluates whether behavioral and pharmacological sleep interventions also reduce suicidal ideation. Findings suggest a small effect such that sleep interventions reduce suicide ideation that did not reach the level of statistical significance. Authors suggest that given the small sample size and heterogeneity of methods that additional work is needed to explore whether sleep interventions have utility as an adjunctive suicide prevention strategy.) further advance the field with their publication of a meta-analysis of eight studies which examined the impact of sleep interventions on the reduction of suicidal ideation. Analyses of the available studies indicates small effects on suicidal ideation that did not reach the level of statistical significance. The authors note, however, that the small sample of studies and heterogeneity of their design calls for further research into the area before conclusions can be drawn. Multiple pathways may contribute to the development and course of suicide risk among older adults. We highlight factors linked to suicidal ideation and behavior, ranging from psychological factors such as depression and cognitive decline, to physiological disruptions in serotonin pathways and circadian rhythm. Screening for insomnia and suicide risk in older adults remains a key part of early identification and intervention to reduce risk and improve quality of life. Making evidence-based interventions to address both insomnia and suicide risk, such as cognitive-behavioral therapy for insomnia, more broadly available is indicated.